Provider Demographics
NPI:1902486020
Name:EVANS, KRISTY ELAINE
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:ELAINE
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 E RIVERBEND
Mailing Address - Street 2:
Mailing Address - City:CUSHING
Mailing Address - State:OK
Mailing Address - Zip Code:74023-5770
Mailing Address - Country:US
Mailing Address - Phone:918-399-0084
Mailing Address - Fax:
Practice Address - Street 1:3810 E RIVERBEND
Practice Address - Street 2:
Practice Address - City:CUSHING
Practice Address - State:OK
Practice Address - Zip Code:74023-5770
Practice Address - Country:US
Practice Address - Phone:918-399-0084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator